Sharing news breast cancer has come back is worse than giving initial diagnosis
"Hearing the sad news that breast cancer has returned can be a devastating experience for patients, especially as this means that the disease is no longer curable. Doctors also find imparting this information to women with whom they have developed a trusting relationship over the years extremely distressing. However, optimal use of available treatments will enable more women to stay cancer-free and reduce the number of these sad, bad and difficult conversations."
"Doctors meanwhile need help learning how to communicate distressing information in honest, positive and supportive ways.”
This is the resume of Professor Lesley Fallowfield, Professor of Psychosocial Oncology, UK that is shared by most of physicians: New research, published in Current Medical Research and Opinion, reveals over threequarters of doctors (78%) find telling women their breast cancer has come back so difficult that they consider it even worse than breaking the devastating news of the original diagnosis.1 When breast cancer comes back, it results in a significant emotional and physical burden on patients and their doctors. For most women, recurrence means their cancer is ultimately no longer curable. Sharing such painful news with a patient and her family is particularly difficult for doctors, with almost half (44%) saying they find discussing recurrence the most stressful part of their job.
Protecting women from recurrence is the number one priority for doctors treating hormone receptor-positive early breast cancer. As breast cancer is most likely to come back in the first 18 months following diagnosis, prescribing the most effective treatment as early as possible, to minimise the risk of recurrence, is key to saving lives. The majority of women who took part in the research (83%) place their trust in their doctor and are confident they will be given the best treatment available to keep them disease-free.However, if their
cancer comes back, 41% of patients admit their trust in their doctor would decrease.
For doctors to be certain they are making the best treatment choice for patients, the research shows almost all (91%) rely on comprehensive clinical data.In addition to a strong evidence base, doctors say their experience with a particular treatment is a key factor in selecting the most appropriate treatment. Dr Mark Lansdown, a consulting surgeon based in the UK, comments: “Doctors treating breast cancer have a very
trusting relationship with their patients. To protect that trust, doctors need to have confidence in their treatment decisions, which directly impact on patients’ lives.”
Dr Lansdown continues: “It is important that we base our treatment strategy on robust and mature clinical data to generate a sense of confidence for prescribing oncologists. A good example of this is the change in treatment strategies we have seen in response to the wealth of clinical data on aromatase inhibitors. In postmenopausal women these are now replacing tamoxifen as the gold-standard treatment choice for preventing recurrence of breast cancer.”
The most mature clinical data set on aromatase inhibitors (AIs) is seen with the ARIMIDEX, Tamoxifen, alone or in Combination trial (ATAC). ATAC was the first reported trial to compare tamoxifen with an aromatase inhibitor as upfront adjuvant hormonal therapy, showing superior efficacy at preventing recurrence even four years after treatment ends (24% reduced risk of recurrence with the AI anastrozole compared with tamoxifen).
The survey, also presented at the recent 6th European Breast Cancer Conference, reveals 78% of physicians would recommend anastrozole for their family or themselves, highlighting the importance of evidence and personal experience which lead to confidence and trust in treatment choice.
As the primary source of information for 87% of breast cancer patients, it is crucial doctors feel supported, prepared and equipped to talk with their patients about the risks of recurrence and the most effective means of preventing it.However, evidence suggests patients can find it hard to absorb this information3 and it has been proposed that interventions to support doctors to improve their communications skills and stressmanagement techniques, would improve consultations and lead to better quality care. As part of their commitment to support healthcare professionals managing breast cancer, AstraZeneca is working with doctors and communication experts to develop training materials, to help doctors and women with breast cancer communicate more effectively around recurrence. These training materials can be accessed on the Breast Cancer Source website at www.breastcancersource.com.
17.06.2008
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